Vaccination strategies against hepatitis A in southern Europe

Hepatitis A virus (HAV) infection is decreasing in southern European countries, where epidemiological conditions vary among regions depending on the social and health-care system development. In high endemic settings, HAV infection has not heavy social and economic weight while in countries with a moderate/low degree of endemia there is a call for targeted vaccination policy. In countries, like Spain and in Italy, where several studies confirm an increase in susceptible adults, vaccination strategies have been applied and recommendations have been published about hepatitis A prevention. Universal hepatitis A immunization seems economically unattractive and most evidences for targeted vaccination have not yet been sufficiently investigated. Vaccine should be used to protect travellers to countries where HAV infection is a major risk and in preventing secondary cases and outbreaks.